Re: Norvir

[Guest guest]

Someone asked me by email how much it costs to determine your protease drug trough level through gas chromatography, and if insurance pays for it.

From my online records it appears that the charge for Reyataz levels through gas chromatography is $160.00 on which Blue Shield paid $89.76 with a $70.24 discount.

Its quite an economical way to be certain your drug dosing is sufficient regardless of which dosng method you use.

I measured my trough Reyataz levels with Norvir once a day, at the higher Reyataz level my Doctor suggested (800 mg) without Novir twice a day, and the same higher dose one a day without Norvir. In anoher few days I will test the results of two weeks on 600 mg per day.

>> You give me a lot to think about... I'm having fair results with Kaletra/ Viread/ Rescriptor (1200 viral load this month from undetectable a year ago), but wouldn't take the once a day dosing because I'm familiar with Norvir side effects. I took both doses one morning by mistake and got all the old toxic symptoms I recall from my six months on full dose Norvir. I think I may discuss with my doctor un-boosted Reyataz instead. I had a terrible time finding an anti-depressant that didn't make me nuts. A pharmacologist I consulted said Norvir would be a very reasonable suspect in that. Also, Reyataz is one drug I'm still "sensitive" to.> > Thanks for another perspective. If I'm going to switch from Kaletra, it may be a good time to give something a shot that's outside the box. I'm also having an apparent lipoma biopsied next month. I'm getting them a lot now in my arms and torso and want to make sure the diagnosis is correct. I'd hoped it would be a simple in-office procedure, but there's an OR and anesthesiologist scheduled! Guess it beats buffalo hump, but I never would have seen these weird conditions coming 10 years ago.> > BG> Re: Norvir> > > Although I was HIV+ for fifteen years and very drug experienced I switched to Reyataz without Norvir in 2003, after eight years of Crixivan usage without Norvir. These non-boosted regimens served me well, and I never developed viral resistance to either drug.> > In 2005 we switched to a new Doctor, who like many, was caught up in the Norvir-boosting hysteria. We did a gas chromatography measurement of my trough Reyataz levels and discovered they were 20% above what was required. Owing to the possibility that some odd series of coincidences might cut drug levels beyond my 20% safety margin I agreed to try Norvir boosting. In retrospect, this was a mistake. Norvir indiscriminately "boosts" the levels of many drugs and toxins, in addition to the targeted protease inhibitor.> > Doubling my 400 mg Reyataz once a day dose, to 800 mg once per day, has dramatically increased the 20% safety margin I enjoyed using a standard dose of un-boosted Reyataz. This higher Reyetaz dose has reduced side-effects, such as Bilirubin levels, when compared with Norvir-boosted Reyataz usage. Of course this has also eliminated the problem of excessively boosted non-target drugs like Viread - which led to serious kidney toxicity in my partner.> > I feel much better, with much better energy levels, having stopped the Norvir. I'm glad that nine month experiment is behind me.> > I have also tried out 400 mg Reyataz twice a day, which should have resulted in an even higher trough level of Reyataz than simply doubling the once daily dose. I will know by how much when we get those results back. The one annoying aspect to commercial gas chromotography is that it takes six to eight weeks to get the results.> > For those, like yourself, who are overly concerned about a higher initial dose, switching to twice daily dosing is the most effective solution to address your concerns. > > For those interested in the math, the trough level of a drug is determined with this formula: > > Trough Dose = Starting Dose / ( 2 ^ (Elapsed Time / Half-Life) )> > As an example, splitting a daily dose of Reyataz into two daily doses should increase the trough-level of the drug by 64% over a once daily doing. This is based on a 7 hour drug half-life. While this formula can give you a good idea of what should happen, your personal drug trough levels should always be confirmed with a gas chromatography blood test.> > A higher protease inhibitor dose, or twice daily dose is an effective and appropriate alternative to the cult of Norvir-boosting for all protease inhibitors, other than Invirase. Unfortunately Invirase suffers from truly bad absorption problems and simply cannot be used without Norvir. But the problems faced by Invirase users should not be generalized to those who have chose more effective protease inhibitors.>